Incisional Hernia | Advanced Surgical & Bariatrics of NJ

Incisional Hernia

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What causes an incisional hernia?

An incisional hernia is one that forms in a previous incision from prior surgery. The incidence of a hernia forming in a previous abdominal scar is approximately 20-60%, and higher in people who are obese or who are active smokers.  The hernia defect itself can form anywhere along the scar tissue of a previous incision, and can be very small to large and complex.  Incisional hernias can develop slowly over many years or can even occur within a few years after surgery.  The underlying cause is usually due to inadequate healing or excessive pressure on the abdominal wall scar.

Who is at risk for incisional hernias?

Conditions that increase strain on the abdominal wall such as obesity, pregnancy, peritoneal dialysis, liver disease, chronic straining/lifting, chronic cough, or chronic difficulties with bowel movements or urination are risk factors for hernia formation.  Also smoking, advanced age, malnutrition, oral steroid medications, chemotherapy, and hematoma or infection after a prior surgery put a patient at a higher risk of developing an incisional hernia, due to poor tissue healing and/or development of healing tissue that has poor mechanical integrity.

What are the symptoms?

Pain is usually the first symptom a person will have with an incisional hernia, regardless of whether or not they have a bulge at the incision site or the abdomen. Once the bulge is present, it can increase in size and gradually cause more symptoms such as nausea and vomiting. If internal organs such as intestine becomes entrapped in the hernia defect, this can be life-threatening if left undiagnosed and untreated.

How is an incisional hernia treated?

Surgical repair of an incisional hernia is largely dependent on reducing or eliminating the mechanical tension present at the hernia site.  The method that is preferred by most hernia surgeons is a tension-free technique and is used by most medical centers. This procedure involves closing the defect and placing a piece of fabric-like netting to reinforce the abdominal wall. Once the mesh becomes fully integrated into the abdominal wall as the area heals, it provides mechanical strength to the previously weakened area, thereby protecting the abdomen from hernia recurrence.

How is incisional hernia repair performed?

This procedure can be done in two different ways; by conventional open repair through one long incision, or via laparoscopic/robotic approach (i.e. minimally invasive repair) with several small incisions.  In the conventional open repair technique, the hernia is repaired through a large abdominal incision.  If intestines are trapped in the hernia (incarcerated), or if they have become twisted off from their blood supply (strangulated) this often requires that part of the intestine to be removed with the remaining ends reconnected (resection and anastomosis).   In a minimally invasive repair, small incisions are made and a tube-like camera and instruments are used to do all the work.  The method of repair depends on many factors, and operative planning often requires preoperative imaging such as CT scan. Our experienced surgeons at Advanced Surgical and Bariatrics of NJ will meet with you to discuss which option is best for you. The main advantages of minimally-invasive hernia repair are reduced risk of mesh infection, and reduced pain and downtime after surgery.

Dr. Sadek

Dr. Ragui Sadek is a premier surgeon who established a state-of-the-art and one of the safest bariatric surgery programs in the state. Dr. Sadek has fellowship training in both laparoscopic/bariatric surgery and surgical trauma/critical care, allowing him to safely perform complex surgeries on patients who have been turned down by other practices. As a Clinical Assistant Professor of surgery at RWJ Medical School & the Director of bariatric surgery program at RWJ University Hospital, Dr. Sadek offers a cutting-edge range of laparoscopic, robotic, & bariatric surgical procedures with a complication rate substantially below the national average.

Dr. Sadek is a Clinical Assistant Professor of Surgery at Rutgers-Robert Wood Johnson Medical School and a Fellow of the American College of Surgeons. Having performed more than three thousand advanced surgical procedures, Dr. Sadek has established a strong patient satisfaction rate and a solid reputation among the surgical community and is renowned as a top physician in his field by International Association of Healthcare Professionals. As a board-certified surgeon, he holds affiliations with the American Society of Metabolic and Bariatric Surgery and the Society of American Gastro Endoscopic Surgeons. More about Dr. Sadek

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